Provider Demographics
NPI:1760887699
Name:KEVIN M. WELCH
Entity Type:Organization
Organization Name:KEVIN M. WELCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:WELCH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:570-742-9636
Mailing Address - Street 1:966 CARPENTER RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:PA
Mailing Address - Zip Code:17847-7527
Mailing Address - Country:US
Mailing Address - Phone:570-742-9636
Mailing Address - Fax:570-742-4661
Practice Address - Street 1:966 CARPENTER RD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:PA
Practice Address - Zip Code:17847-7527
Practice Address - Country:US
Practice Address - Phone:570-742-9636
Practice Address - Fax:570-742-4661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003430L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty